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INSTRUCTIONS <br /> „ 3u .ary t2, years. <br /> -. Your sanitary permit may oe renewec before One expiration dateana at the time of renewal any new <br /> . ritenn in the Wisconsin Admmistratwe Codc ai!! be applicab!c. <br /> AI' 1 ;.ons TM this pair nt mast be approved by the permit issuing authority_ <br /> .f- Changes in ownership or p!umber requires a San,tary Permit Transter/Renee..at Form (SBD 63991 to be <br /> submitted to the county prior to installation. <br /> _- Onsite sewage systems must be properly maintained. The septic tarkis) must be pumped by a licensed <br /> y l: j.61 Wilefiever neuc ',V y. .,..cai:y cve:q a, yr3af 5. <br /> F 'f you have questions concerning your onsite sewage system, contact your local code adm!nistratn- or the <br /> State of Wisconsin, Safety & Buildings Division.. 608 266 3815. - <br /> o be complete and accurate this sanitary permit application must include. <br /> mv,ner s narn.e anlj naiGn., ad'•essthe legal description and parcel tax number(_) n+ <br /> Ahere '11c _;sten-: is to be nstalled. <br /> P;. Type o9 building being served. u,ieck only one and ::amp eta r of u r monis if 1 or 2 ::=amity Dw Jl,-,g. <br /> It Building use. If building type is Public, check all appropriate boxes that apply. <br /> IV. r ype of permit. Check only one in line A Complete line B it permit is for tank replacement, reconnection, or <br /> repair. <br /> Type of system- Check appropriate box depending on system type <br /> \11 Absorption system information. Provioe all information requested in #1-7. <br /> N11 Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number ol <br /> tanks and manufacturers name. Indicate prefab or site constructed and tank material. Complete fcr all <br /> septic, pump/siphon and holding tanks for this system. Check experiments! approval only if tanks received <br /> experimental product approval from DILHR.. <br /> V!II. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. <br /> MP, etc.). address and phone number. Plumber must sign application form. <br /> IX County/Department Use Only. <br /> X. County/Department Use Only. <br /> Complete plans and specifications not smaller than 8Yz x 11 inches must be submitted to the county. The <br /> plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of <br /> holding tank(s), septic tank(s) or other treatment tanks; building,.sewers; wells; water mains/water service; <br /> streams and lakes; pump or siphon tanks; distribution boxes, soil absorption systems; replacement system <br /> areas, and the location of the building served; B) horizontal and vertical elevation reference points; <br /> C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump <br /> performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if <br /> required by the county; E) soil test data on a 115 form; and F) all sizing information. <br /> ------------------—----------------—---------------------------------------------------—------------------------------------------------------------ <br /> GROUNDWATER SURCHARGE <br /> 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of <br /> regulated practices which can effect groundwater. <br /> The monies collected through these surcharges are used for monitoring groundwater, ground- <br /> water contamination investigations and establishment of standards. <br /> SBD--3398(R,!1/8C) <br />